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Crohn's, complex and highly personalized disease

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D. Alwinsky, M.D. |
Crohn's disease
Chronic inflammatory bowel disease   Every patient should use trial and error to see what works and what does not

If there is a disease that we could call interesting from the medical point of view, Crohn's would be it. Symptoms range from mild to severe, it is highly personalized, and number of patients is increasing, particularly in the developing world.

Crohn's disease, a condition that can occur at any time but mostly hits people of 15 to 35 years of age, is an immune related disease which means the body's immune system attacks the gastrointestinal tract or some of its parts.

Crohn's is a complex disease because it can cause complications outside the gastrointestinal tract from mouth to anus.

Its main symptoms are abdominal pain, diarrhea - from mild to bloody - fever, and weight loss. On top of that, there may be anemia, skin rashes, arthritis, and eye inflammation.

Main complications a patient may experience are intestinal obstruction, fistulas, abscesses, anal fissures, ulcers, malnutrition, and different inflammations. As you can see, this is a range of conditions and they require a different approach for every patient.

The problem here is that the disease occurs as a combination of several factors - environmental, immune, bacterial, and genetic - but the true cause, the one and only we can point our finger to, is not clear yet.

However, there are some things common to Crohn's patients.

We know that more than 70 genes are involved and half of the overall risk is related to genetics. Aside from genetics, it Crohn's disease loves smokers and it's twice as frequent with them than with non-smokers. And we know that it often begins after gastroenteritis.

To make things more interesting, we be must careful while diagnosing since it can be similar to Behcet's disease and include irritable bowel syndrome.

There is no drugs that can cure Crohn's and all we can do is to help the patient with symptoms, trying to prevent relapse. But, today we can do that successfully. And we can help the patient a great deal with a good diet.

Let's see first the conditions and their treatment.

Abscesses are treated with antibiotics and they can be drained with a needle or with surgery.

Fistulas can be treated with medicine and diet changes or, if they are severe a surgery is needed.

Anal fissures are treated with including ointments, warm baths, and diet changes.

Now, an intestinal obstruction is serious because a complete obstruction is life treatening and that requires an emergency surgery.

If there is a case of malnutrition present, the patient may need fluids or even feeding tubes.

We see from these treatment types - and the fact that it hits the gastrointestinal tract primarily - that the diet is of extreme importance during this condition.

Since surgery is needed in some cases - and several times again and again in some patients - and since bowel cancer may appear, the best way to fight the disease is the diet.

While thinking about the diet, we must, of course, start with some guidelines that may help a majority of the patients.

The patients with Crohn's should avoid food that can irritate the ways it is coming true: fizzy drinks and high-fiber foods. More liquid is welcome as well as smaller portions eaten more often. Aside of that, the doctor may recommend low salt, low fat, or lactose free diet.

And this is exactly where we can see how personalized Crohn's is.

For example, one patient will tell you that he stopped eating beef and feels well. Another will tell you that the doctor recommended him to avoid beef but he is still eating beef no matter what - and feels well. And another will tell you that he was gradually introducing beef and also feels well.

Another thing you may hear is don't eat pork. Fat is generally bad for Crohn's patient and we know pork contains fat. But, it's not so simple.

For example, lean cuts of pork are high in protein and low in fat and have B-vitamins. In terms of fatty acids, pure lard is better than butter and fatty acids can relive inflammation.

The point of Crohn's diet is to make life of the patient's gastrointestinal tract easier.

A low-fiber diet minimizes demands on the digestive system, thus easing symptoms of Crohn's disease. On the other hand, high-fat, greasy, and fried foods are harder to digest and some 30% of patients can't stand it without complications.

But, there are different types of fats. According to a recent research a diet of plant-derived "good" fats could reduce bacterial diversity, thus helping a large number of patients. Such fat can be found in the coconut oil and cocoa butter, avocados, nuts, salmon, and olive oil.

Dairy products are good for health in general, they are great sources of calcium and that's good for a patient with Crohn's because some drugs may cause a calcium deficiency.

However, dairy products are very often the first food people will leave when diagnosed with Crohn's. While it's true that they may cause some problems, it is not wise to leave that excellent food.

Milk and other dairy products can create problem in lactose intolerant people but we must say that today is almost "in" to say "I'm lactose intolerant" and "I need gluten free diet."

So, if you are not a member of a rare Asian or African community, chances are in your society 90% of people have no problem with milk whatsoever.

So, milk, cheese and other products are welcome. And if you are lactose intolerant, there is almond milk as a great substitute for regular milk.

Fiber you can find in raw vegetables and fruits draws water into the colon and can worsen diarrhea but there is oatmeal with soluble fiber that passes more slowly through patient's digestive tract.

Then, there are tropical fruits, such as papaya, easy to digest yet full of vitamins and it also has enzyme called papain which helps the body digest proteins.

You see, the patient must not stick blindly to "not eat that, eat this." The rule of thumb is good - eat food that doesn't irritate - every patient should use trial and error to see what works and what doesn't.

Along with the diet, attention must be paid to medication we take for granted. Drugs such as aspirin or ibuprofen can trigger flare and if the patient needs an anti-inflammatory drug, she should ask the doctor what are other choices.

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